Anal endosonographic assessment of the accuracy of clinical diagnosis of obstetric anal sphincter injury

Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are a common cause of maternal morbidity with an overall incidence in the UK of 2.9% (range 0–8%). They can cause a range of physical symptoms and psychological distress. This study aims to assess the accuracy of clinical diagnosis of OASIS using endoanal ultrasound (EAUS) and the correlation between confirmed injury and change to anorectal physiology squeeze pressure and the incidence of bowel symptoms. Methods and materials Retrospective study of prospectively collected data from 1135 women who attended the Third- and Fourth-Degree Tears Clinic at our institution, 12 weeks post-delivery, between June 2008 and October 2019. Results OASIS was confirmed in 876 (78.8%) women and 236 (21.3%) had no injury. Of the women who underwent anorectal physiology, 45.6% had a mean maximal resting pressure below the normal range and 68.8% had a mean incremental squeeze pressure below normal. Women with confirmed OASIS had significantly lower pressures (p < 0.001) than those without a confirmed sphincter injury. Three hundred ninety-three (34.8%) women reported bowel symptoms, with those with endosonographic evidence of injury more likely to develop flatus incontinence. Conclusion Of the women in this study with a suspected OASIS, 21.2% could be reassured that they did not have an injury. This information is useful for women considering future mode of delivery. Those with confirmed injury are more likely to complain of flatus incontinence and have reduced anal sphincter pressures.

Is Fecal Calprotectin an Applicable Biomarker of Gut Immune System Activation in Chronic Inflammatory Demyelinating Polyneuropathy? – A Pilot Study

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a complex autoimmune disease caused by dysregulated response to not fully recognized antigens. Some association between CIDP and inflammatory bowel disease (IBD) has been reported, but the exact pathophysiological links of these disorders are not well understood.Aim of the Study: To evaluate fecal calprotectin as a biomarker of gut inflammation in CIDP patients without IBD.Methods: Fifteen patients with CIDP and 15 healthy controls were included in the study. The CIDP diagnosis was based on the EFNS/PNS criteria. The occurrence of bowel symptoms was assessed based on a questionnaire. The quantitative evaluation of fecal calprotectin level was performed by the ELISA test.Results: The fecal calprotectin level (μg/g) expressed as median along with the lower and upper quartiles [25Q–75Q] was significantly higher in CIDP patients compared to the controls: 26.6 [17.5–109.0] vs 15.6 [7.1–24.1], p = 0.0066. Abnormal fecal calprotectin level (&gt;50 μg/g) was found in 33% of all CIDP patients and in none of the control subjects. The patients with abnormal fecal calprotectin level did not differ from the rest of the study group regarding the neurological status. The most common bowel symptoms reported by CIDP patients included constipation (33%), feeling of incomplete evacuation (33%), bloating (27%), and alternating bowel movement pattern (27%).Conclusion: In one-third of CIDP patients the signs of gut immune system activation have been observed. This finding may be associated with CIDP pathogenesis and induction of autoimmune response as well as concomitant dysautonomia with gastrointestinal symptoms.

451 Metastatic Cervical Cancer to the Duodenum: A Learning Point

Background Carcinoma of the Cervix is the second most common gynaecological malignancy. It usually spreads in a predictable manner with most via direct extension to surrounding structures. When distant metastases present, they usually spread haematogenously and via the lymphatics to the liver, lung and bone marrow. Metastatic spread to the duodenum is rare with only 15 reported cases identifying spread to the bowel. Case Presentation An 81-year-old lady presented with signs and symptoms consistent with bowel obstruction with a background of renal cell carcinoma and cervical cancer. Investigations identified gastric outlet obstruction. Subsequent oesophago-gastroduodenoscopy showed structuring at D1/D2 and a enteric stent was inserted. Biopsies taken at the time showed lymphovascular permeation of the mucosa and submucosa by nests of tumour cells resembling squamous cells. The cells were P16 and P63 positive and FISH analysis detected Human papilloma virus 16. The tissue was identified as metastatic cervical cancer. The patient subsequently did not want further interventions and was referred to palliative care and subsequently passed away due to her illness. Conclusions Few reported cases of metastatic cervical cancer to the bowel have been reported. Of these, most commonly they have presented with obstructive bowel symptoms and metastasised to the duodenum such as in this case. The pathophysiology for this manner of transmission is poorly understood in literature. Obstructive bowel symptoms on the background of cervical cancer should raise the possibility of metastases in future practice.